Month: September 2022

Source: United States Department of Justice News

BROWNSVILLE, Texas ‐ A 49-year-old Brownsville man has been charged for his role in a scheme to defraud Medicaid by working with a suspended medical license, announced U.S. Attorney Jennifer Lowery.

Law enforcement took Fernando Mendez into custody this past weekend. He is expected to make his initial appearance before U.S. Magistrate Judge Ronald G. Morgan at 9:30 a.m. today.

According to the indictment, returned Aug. 26 and unsealed today, Mendez was a physician assistant at CCI Therapy Counseling Centers International.

On July 20, 2021, the Texas Medical Board allegedly ordered the immediate suspension of Mendez’s physician assistant license, deeming him to be a “continuing threat to public welfare.” He was then prohibited from practicing medicine, according to the charges.

However, Mendez allegedly continued to evaluate and treat patients at mental health clinics in Brownsville, Harlingen and Pharr and billed Medicaid for services he rendered during his suspension.

The indictment further alleges Mendez attempted to conceal his continued practice of medicine by using identities of other physicians and medical personnel. Specifically, Mendez allegedly created medical records under the identities of other physicians while they were traveling outside of the United States. The charges also allege Mendez submitted false statements to the Texas Medical Board in an effort to conceal his improper practice of medicine.

Mendez is charged with seven counts of health care fraud for which he faces up to 10 years in federal prison. If convicted of any of the four aggravated identity theft charges, he faces another two years which must be served consecutively to any other prison term imposed. All counts also carry as possible fine of up to $250,000.

The FBI, Department of Health and Human Services-Office of Inspector General, Texas Health and Human Services and Texas Attorney General’s Medicaid Fraud Control Unit, and Department of Homeland Security-Office of Inspector General conducted the investigation. Assistant U.S. Attorney Andrew Swartz is prosecuting the case.

An indictment is a formal accusation of criminal conduct, not evidence.
A defendant is presumed innocent unless convicted through due process of law.

Source: United States Department of Justice News

CHARLESTON, W.Va. – United States Attorney Will Thompson and the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG) announced today that Dr. Craig M. Morgan and Eye Consultants of Huntington Inc. have paid $907,074.64 to resolve allegations that they submitted false claims to Medicare and Medicaid.

From January 13, 2013 through April 12, 2019, Morgan routinely administered vascular endothelial growth factor inhibitor injections into the eyes of patients to treat purported wet age-related macular degeneration (Wet-AMD) or other ophthalmological conditions for which treatment with such injections is indicated. These injections were not medically necessary because the patients in question did not have treatable Wet-AMD or any other condition that would have warranted the invasive treatment at the time it was administered.

“This settlement is important because it shows that this office, along with its federal partners, will aggressively seek re-imbursement when taxpayer money is spent wrongly,” Thompson said. “When a person goes to a medical provider, they expect the medical provider to treat them, not for the medical provider to figure out ways to enrich themselves.”

Morgan was identified by HHS-OIG as one of the top outliers for billing the Medicare program across all medical specialists in West Virginia, far exceeding the average of Medicare claims submitted by his peers. The vast majority of payments Morgan received from Medicare were for injections for purported treatment of Wet-AMD.  

“Providers who perform medically unnecessary procedures damage the trust of physician-patient relationships and exploit taxpayer-funded programs,” said HHS-OIG Special Agent in Charge Maureen Dixon. “HHS-OIG, and our law enforcement partners, are committed to working together to protect the integrity of federal health care programs.”

The case was investigated by HHS-OIG and the Federal Bureau of Investigation (FBI) in collaboration with the United States Attorney’s Health Care Fraud Task Force, which brings together federal, state, and local law enforcement partners from numerous agencies to coordinate intelligence sharing and prosecution of health care fraud impacting Medicare, Medicaid, and other public health care programs.

“I commend their investigative work and the handling of this case by Assistant United States Attorneys Gregory Neil, Matthew Lindsay, and Jennifer Mankins,” Thompson said.

 A copy of this press release is located on the website of the U.S. Attorney’s Office for the Southern District of West Virginia.

 

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Source: United States Department of Justice News

U.S. Attorney Ronald C. Gathe, Jr. announced that the State of Louisiana has received $70,003 from the Department of Justice’s Office of Justice Programs and its component, the Bureau of Justice Statistics, to expand, enhance, and maintain criminal justice data from law enforcement and construct a criminal justice performance retrieval system.  The criminal justice performance retrieval system will improve the ability to access statewide criminal justice data for purposes of research, analysis, data sharing and compiling reports to assist Louisiana lawmakers.  

The recipient of this award, the Louisiana Commission on Law Enforcement, is a foundation located in Baton Rouge dedicated to improving the operations of the criminal justice and juvenile justice systems and to promoting public safety by providing progressive leadership and coordination within the criminal justice community.